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Eczema

Eczema is frequently called atopic dermatitis because it was noted to occur in individuals with allergic symptoms, e.g., allergic rhinitis (hay fever) and asthma. The term atopic simply means allergic. Even though eczema was considered to be an allergic problem, allergy seems to be less likely as our understanding of the disease increases. Physicians know that eczema is a very complex disease and contains allergic as well as non-allergic elements in different individuals. As a result, the treatment of every individual may vary.

While the causes of eczema continue to be investigated, certain things are known about the disease. The skin is much more easily irritated than normal skin. Dryness of the skin is a primary component and results in significant itching. Eczema is known as “the itch that rashes”. Itching is made worse by irritants on the skin. Winter months are particularly bothersome because of the dry winter air. Flares in the summer months can occur after exercise because sweat is a significant irritant. Citrus or some vegetables, e.g., tomato, can act as a primary irritant when they touch the skin. Stress in some individuals can affect the skin. While emotional factors may play a role in flaring eczema, they are not considered a primary source of causing the onset of eczema, if it is not already present.

Eczema occurs in about 3% of the population. In about 80% of those individuals, the onset occurs in the first year of life. One-half are free of disease by age 2 years, about one-fourth by the end of adolescence, and the remaining one-fourth will continue to have eczema into adult life. Some individuals do not have the onset of symptoms until adolescence or adulthood.

Treatment is multifaceted and includes lifestyle modification as well as various types of medication. A portion of treatment will be listed in the accompanying tables. Adequate attention to clothing, diet manipulation, and attention to the emotional well-being of the affected patient are very important. It is preferable for a patient with eczema to wear clothing which will not irritate the skin; soft cotton material would be best. The room temperature should be kept moderate with controlled humidity (between 35-50%). Overheating and perspiration should be avoided.

Some investigators believe there is a genetic tendency for eczema with approximately 50% of eczema patients ultimately developing allergic rhinitis and/or asthma. This is compared to about 20% without the presence of eczema. While allergy skin testing and allergy injection treatment are usually helpful in cases of allergic rhinitis and/or asthma, it is generally agreed that this is often not the case with eczema. In some individuals, starting allergy shots for allergic rhinitis and/or asthma may actually result in significant flaring of the eczema.

Prevention

  • Trim fingernails short
  • Cotton gloves at night if needed to decrease scratching
  • Clothing should be double rinsed after washing to remove all residual detergent (irritants)
  • Avoid excessive room temperatures
  • Wear light, non-occlusive clothing (e.g., cotton instead of polyester)
  • Keep the bedroom moderate (cool) and avoid excessive bed clothing
  • Allergen contact or ingestion avoidance (e.g., foods, pets, dust mite) can reduce stimulation of the skin

Treatment

  • Bathing for moisturization, e.g., soaking in tepid water for 30-45 minutes at least once daily and if possible 2-3 times.
  • Within 2 minutes after getting out of the tub, a lubricating cream or ointment should be applied to help hold the moisture in the skin. Examples include Aquaphor, Curel, Moisturel, Eucerin, Keri, Lubriderm, Acid Mantle, Unibase, Vanicream, petrolatum, and chilled Noxzema,etc. Newer medications include Triceram/Certopic, Impruv, Mimyx, Nourica Repair, Cerave, Atopiclair, and Hylira. Some of the newer medications are by prescription only. None of the medications in the above list contain steroids.
  • In general, lotions should be avoided since they contain alcohol which may sting and provide limited moisture.
  • If marked irritation or weeping areas are present, wet wraps with a drying solution (e.g., Burrow’s solution, one tablet mixed in one quart of water is available by prescription) will avoid the stinging or burning sensation that can occur with bathing.
  • Addition of oil or similar substances to the bath water generally has little effect on increasing moisturization.
  • Pat dry with a soft towel; do not “rub” dry since this will remove natural, protective oils from the skin.
  • Showers do not add moisture to the skin and actually remove the protective oils from the skin resulting in increased dryness.
  • Topical steroids are the mainstay of therapy for more severe eczema. Ointments or creams are generally used.
  • Nonsteroidal medications that help the immune system in the skin may be necessary either in addition to or in place of topical steroids if the topical steroids are not adequate for relief. Examples of the nonsteroidal medications are Elidel and Protopic.
  • Antibiotics, topical and/or oral, may be needed if the lesions become infected. An alternative to antibiotics is the use of Clorox baths. One-quarter to one-half cup of Clorox in a full bath provides antibacterial activity that will treat all known bacterial infections. No resistant bacteria to Clorox are known.

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May is Allergy and Asthma Awareness Month

Breathe Better with Asthma, Wherever You Are

If you have asthma, you know that symptoms can come on quickly, then worsen. The things that make them do that are called triggers. An important part of managing asthma is knowing what your triggers are — at home, work, school, or while you’re outdoors. A healthcare provider can help you figure that out, then you can take steps to avoid those triggers and breathe easier.

At home

Because asthma is usually due to allergies, triggers are often allergens, or things that cause allergic reactions. Allergens such as pet dander, dust mites, pests, and smoke can make asthma symptoms worse in some people, and for others, even trigger an asthma attack. The National Heart, Lung, and Blood Institute (NHLBI) suggests that it may be helpful to combine a few different strategies to help reduce exposure to triggers. People sensitive to dust can clean with a high-efficiency particulate air (HEPA) filtration vacuum and use mattress and pillow covers that prevent exposure to dust mites. If you’re sensitive to pests like cockroaches and rodents, consider integrated pest management, which involves removing and controlling pests through methods such as traps or poison. Avoiding tobacco smoke, including secondhand smoke, can be especially helpful for some people with asthma.

At school

Asthma is one of the leading reasons children miss school. At school, kids may be exposed to dust mites, pests, and mold, which may be asthma triggers for some children. Because children spend lots of time at school, it can be helpful for teachers, school nurses, or coaches to know what to do if your child’s symptoms flare up. Team up with a healthcare provider to develop an asthma action plan and share it with trusted adults at your child’s school.

At work

The workplace can have hundreds of potential triggers, like chlorine-based cleaning products, bleaches, hair dyes, and metal dust. Repeated exposures in the workplace can also lead to new triggers. Report new or worsening symptoms that occur at work to your healthcare provider and your workplace supervisor.

Outdoors

Everyday weather like cold, dry air can set off breathing problems. Air pollution can affect asthma, too. It may be helpful to avoid some of the worst pollution by adjusting when and where you exercise. Try to avoid exercising near busy roads or industrial areas. Visit airnow.gov to check your local air quality so you can plan to avoid outdoor activities when pollution is highest.

Managing your triggers is just one part of keeping your asthma under control. Work with a healthcare provider to develop an asthma treatment plan that includes taking medicines as prescribed and keeping track of your symptoms and where you are when they occur. That way, you can know what’s making your asthma worse or better.

Want to learn more about asthma? Visit NHLBI’s Learn More Breathe Better® program at nhlbi.nih.gov/BreatheBetter. Or make an appointment to meet with one of our asthma specialists at Oklahoma Allergy & Asthma Clinic 405-235-0040.

The post May is Allergy and Asthma Awareness Month appeared first on Oklahoma Allergy and Asthma Clinic.

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